11/16/2023 0 Comments Dot blot hemorrhage eye![]() This comes under abusive head trauma (AHT), is seen in young children caused by repeated acceleration-deceleration injury. Breakthrough hemorrhage into vitreous also happens in malignant choroidal melanoma, retinal vascular occlusions, and idiopathic polypoidal choroidal vasculopathy (IPCV). A subretinal hemorrhage can cause a breakthrough bleeding into the vitreous. They are commonly seen due to the rupture of a vessel, as seen commonly in proliferative diabetic retinopathy, retinal arteriolar microaneurysm, or during posterior vitreous detachment. Chronic hemorrhages appear as diffuse vitreous clouding with settled blood inferiorly. īleeding into the vitreous cavity is seen as fresh blood clots with sudden onset of floaters. Valsalva retinopathy is a pre-retinal hemorrhage caused by a sudden increase in intra-thoracic or intra-abdominal pressure. Hemorrhage may be present in the vitreous, subhyaloid, or intraretinal /sub-internal limiting membrane. Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, intracerebral hemorrhage, or traumatic brain injury. Causes include Terson syndrome, Valsalva retinopathy, proliferative diabetic retinopathy, and proliferative retinopathy after retinal vein occlusions. Preretinal hemorrhages are “boat” or ‘D’ shaped hemorrhages which collect between the posterior limiting membrane of the vitreous and internal limiting membrane (ILM) of the retina. They are commonly seen in choroidal neovascular membranes (CNVM), choroidal tumors, and choroidal rupture secondary to acute trauma. These hemorrhages are located between RPE and Bruch membrane and appear dark red with well-defined sharp borders. Sub-macular hemorrhages are commonly seen in choroidal neovascular membranes secondary to ARMD. Such hemorrhages are commonly seen in ARMD, presumed ocular histoplasmosis, high myopia, PCV, retinal macroaneurysm, and trauma. The hemorrhages are deep red in color and broader in shape with diffuse margins. These hemorrhages occur between the photoreceptor layer and retinal pigment epithelium (RPE). Purtscher-like retinopathy is seen in acute pancreatitis, renal failure, and autoimmune disease. Retinal findings are intraretinal whitening, cotton wool spots, and intraretinal hemorrhages. Purtsher retinopathy is an occlusive microvasculopathy associated with cranial or thoracic compressive trauma. Common causes for such hemorrhages include diabetic retinopathy, retinal vein occlusions, ocular ischemic syndrome, sickle cell retinopathy, and juxta foveal telangiectasia. These are dense, dark red, sharply outlined, and are seen in disorders that affect the pre-venular deep capillary layer. These dot and blot hemorrhages are found within the inner nuclear and outer plexiform layers of the retina. Roth spots are characteristic of subacute bacterial endocarditis and also seen in leukemia, anemia, anoxia, and other rare conditions. Capillary rupture with extravasation, and central fibrin–platelet plug gives the white center to the Roth spot. It was Litten who described the association (Litten sign) and referred to it as Roth spots. It is known that a correlation exists between the severity of ocular and intracranial injury and the presence of numerous RHs (2).Roth spots: Roth spots are round in shape with a white center. The primary mechanism of RHs in child abuse is mechanical with resultant shearing and damage to the retinal blood vessels, with or without direct blunt injury to the child. The number of hemorrhages and extent into the periphery (to the ora) also increase the likelihood that non-accidental trauma has occurred. Bilateral hemorrhages in multiple levels of the retina (i.e., pre, intra, and subretinal) and paramacular folds further raise the suspicion of child abuse. ![]() If intracranial pathology (e.g., subdural hematoma) is present without an identifiable etiology, one must suspect repetitive shaking or repetitive impact (resulting in repetitive rotational forces on the head) as the most likely cause of the RHs. It is prudent to rule out other causes by history, physical exam, and laboratory testing. The differential diagnosis for retinal hemorrhages in an infant includes non-accidental trauma, sepsis, coagulopathy, leukemia, uncontrolled hypertension, cardiopulmonary resuscitation, and hyperviscosity syndromes, amongst others (1). Retinal hemorrhages (RHs) are present throughout the macula and periphery of both eyes in this 4-month-old child.
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